Systems and methods for electrochemical point-of-care detection of hemoglobin

ABSTRACT

A method is disclosed comprising lysing the red blood cells of a whole blood sample, oxidizing the free hemoglobin in the lysed sample, and cleaving FVH from the hemoglobin A1C to form an electrochemical test solution. In one aspect, a first portion of the electrochemical test solution is reacted with fructosyl peptide oxidase and a reduced ruthenium mediator to form a first reaction product. A first electrical property of the first reaction product is measured, the measurement being indicative of hemoglobin A1C in the blood sample. In another aspect, a second portion of the electrochemical test solution is reacted with ferrocyanide to form a second reaction product. A second electrical property of the second reaction product is measured, the measurement being indicative of total hemoglobin in the blood sample. Hemoglobin A1C, total hemoglobin, and % HbA1C are determined based on the first and second electrical properties. Also provided are systems and components useful in performing the disclosed methods.

CROSS REFERENCE

This application is a divisional application of U.S. patent applicationSer. No. 16/698,872 filed Nov. 27, 2019 and claims the benefit of U.S.provisional application No. 62/772,789, filed Nov. 29, 2018, theentirety of which is hereby incorporated by reference.

BACKGROUND

Glycation of hemoglobin occurs primarily at the amino termini of betachains, as well as other sites with free amino groups. The mostprevalent and well-characterized species of glycated hemoglobin A isA1C, making up approximately 3% to 6% of the total hemoglobin in healthyindividuals. Hemoglobin A undergoes a slow glycation with glucose thatis dependent on the time-average concentration of glucose over the120-day life span of red blood cells. Hemoglobin A1C (“HbA1C”) is a typeof glycated hemoglobin which is formed when glucose binds to theN-terminal valine residue of the β-chains of hemoglobin. The correlationof A1C and blood glucose levels make it a useful method for monitoringlong-term blood glucose levels in people with diabetes. The mean(average) blood glucose level is a function of the A1C levels and istherefore derivable.

% HbA1C is the ratio of glycated A1C hemoglobin to total hemoglobinexpressed as a percentage. % HbA1C is an indicator of how well or howpoorly diabetics have controlled their diabetes, and it can also be anindicator of pre-diabetes. % HbA1C is therefore an important diagnostictool for the diagnosis and treatment of diabetes. The amount of glycatedhemoglobin in the blood as a part of total hemoglobin is a goodindicator of how well the body has managed glucose levels.

Point of Care (“POC”) and home testing for A1C and ultimately % HbA1Care desirable for both patient and doctor. High levels of blood glucosecause over-glycation of proteins, including hemoglobin, throughout thebody. Regular measurement of HbA1C allows doctors to help their patientsbetter manage the disease by providing them with the information toalter their medications, or by suggesting lifestyle changes.

Thus, A1C and % HbA1C measurements are an important indicator in themonitoring and diagnosis of diabetes mellitus. The ability to quicklyand accurately determine A1C and total hemoglobin, particularly in a POCsystem, is therefore of great importance. However, some measurementmethods are unable to provide accurate results across the manyhemoglobin variants found naturally in patients. An electrochemical testcombining determination of both HbA1c and total hemoglobin would beindependent of hemoglobin variants and could determine hemoglobinparameters with a single blood sample. This would represent asignificant step forward in the health care of diabetics.

SUMMARY

In one aspect there is provided a method for electrochemically detectingfree hemoglobin in a sample solution. The free hemoglobin is oxidized toFe⁺³ and fructosyl-valine-histidine (“FVH”) is cleaved, resulting in anelectrochemical test solution comprising a mixture of hemoglobin, FVH,and hemoglobin degradation products. A first portion of theelectrochemical test solution is combined with a chemistry includingfructosyl peptide oxidase (“FPOX”) and a reduced ruthenium mediator toform a first reaction product. A first electrical property of the firstreaction product is measured, this measurement being indicative of theamount of hemoglobin A1C in the sample solution. A second portion of theelectrochemical test solution is combined with a chemistry includingferrocyanide (potassium hexacyanoferrate Fe⁺²) to form a second reactionproduct. A second electrical property of the second reaction product ismeasured, this measurement being indicative of the amount of totalhemoglobin in the sample solution. The A1C and total hemoglobindeterminations are combined to derive % HbA1C. Systems and componentsuseful in the disclosed methods are also provided.

In another aspect, an electrochemical test system for determininghemoglobin A1C and % HbA1C is disclosed. The test system includes asampler and first and second test strips configured to facilitate thedetermination of A1C and total hemoglobin. The sampler includes apre-analytical solution comprising components for lysing red bloodcells, oxidizing free hemoglobin to Fe⁺³, and cleaving FVH from freehemoglobin. The first test strip includes a reaction chemistrycomprising FPOX and a reduced ruthenium mediator. The second test stripincludes a reaction chemistry comprising FPOX and ferrocyanide.

In one aspect, fast, reliable and accurate quantitation of hemoglobinA1C and total hemoglobin in a whole blood sample is achieved. In anotheraspect, quantitation of % HbA1C is accomplished as part of an overallelectrochemical measurement system.

In a further aspect, methods and systems are provided for measuringhemoglobin A1C and total hemoglobin in portions of a singleelectrochemical test solution prepared from a whole blood sample.

As a further aspect, because the measurements are both electrochemical,they do not have a specificity for hemoglobin variants, so differentvariants do not impact the results.

In one embodiment, a method for electrochemically detecting freehemoglobin in a sample solution includes oxidizing the free hemoglobinand cleaving fructosyl-valine-histidine (FVH) from the free hemoglobinto form an electrochemical test solution including a mixture ofhemoglobin, FVH, and hemoglobin degradation products. The method furtherincludes reacting a first portion of the electrochemical test solutionwith a chemistry including fructosyl peptide oxidase and a reducedruthenium mediator to form a first reaction product. The method furtherincludes measuring a first electrical property of the first reactionproduct which is indicative of the amount of hemoglobin A1C in thesample solution. The method further includes reacting a second portionof the mixture with a chemistry including fructosyl peptide oxidase andferrocyanide to form a second reaction product. The method furtherincludes measuring a second electrical property of the second reactionproduct which is indicative of the amount of total hemoglobin in thesample solution. The method further includes determining the amounts ofhemoglobin A1C and of total hemoglobin of the sample solution based onthe measured first and second electrical properties, respectively.Alternatively, the method further includes determining the % HbA1C basedon the determined amounts of hemoglobin A1C and total hemoglobin. In onealternative, the first electrical property is a current produced inresponse to a voltage applied to the first reaction product and themethod includes applying a voltage to the first reaction product,detecting a first resulting current, and determining the amount ofhemoglobin A1C based on the first resulting current. In anotheralternative, the second electrical property is a current produced inresponse to a voltage applied to the second reaction product and themethod includes applying a voltage to the second reaction product,detecting a second resulting current, and determining the amount oftotal hemoglobin based on the second resulting current. Alternatively,the first electrical property is a current produced in response to avoltage applied to the first reaction product and the method includesapplying a voltage to the first reaction product, detecting a firstresulting current, and determining the amount of hemoglobin A1C based onthe first resulting current. In another alternative, the applied voltageis a negative voltage. Alternatively, the applied voltage is a negativevoltage of 525 mV. In one alternative, the oxidizing includes combiningan oxidizing agent with the free hemoglobin. Alternatively, cleavingincludes combining the oxidized free hemoglobin with Neutral EnzymeProteinase. In another alternative, the oxidizing includes combining anoxidizing agent with the free hemoglobin. Alternatively, the samplesolution is a whole blood sample containing red blood cells and themethod further includes prior to the oxidizing and cleaving steps,lysing the red blood cells to form a lysed sample solution containingthe free hemoglobin. In another alternative, oxidizing includescombining an oxidizing agent with the free hemoglobin. Alternatively,the cleaving includes combining the oxidized free hemoglobin withNeutral Enzyme Proteinase. Alternatively, oxidizing includes combiningan oxidizing agent with the free hemoglobin. In another alternative, themixing the lysed sample solution with a pre-analytical solutioncontaining components for performing the steps of lysing, oxidizing andcleaving.

In one embodiment, a system for the determination of A1C and totalhemoglobin includes a sampler including a pre-analytical solutionincluding components for lysing red blood cells, oxidizing freehemoglobin to Fe⁺³, and cleaving FVH from free hemoglobin to form anelectrochemical test solution. The system further includes a first teststrip including a reaction chemistry including fructosyl peptide oxidaseand a reduced ruthenium mediator for the electrochemical determinationof A1C. The system further includes second test strip including areaction chemistry including fructosyl peptide oxidase and ferrocyanidefor the electrochemical determination of total hemoglobin.Alternatively, the pre-analytical solution includes a Neutral EnzymeProteinase. In one alternative, the pre-analytical solution includesZwittergent 3-14. In another alternative, the pre-analytical solutionincludes:

-   -   1.5% Triton X-100;    -   880 mM Imidazole;    -   10 mM NaCl;    -   3 mM CaCl2;    -   47.6 mM Tetradecyltrimethylammonium bromide (TTAB);    -   8.1 mM 1,2-benzoisothiazol-3-one sodium salt (Isothiazoline);        and    -   35 kU/mL NEP-801.        Alternatively, the pre-analytical solution is configured to be        combined with a sample and applied to both the first and second        test strip to achieve an analytical result.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows one embodiment of an electrochemical test strip for use indetermining hemoglobin A1C, total hemoglobin, and % HbA1C;

FIG. 2 shows experimental results for a cyclic voltammetry curve ofcurrent versus potential for embodiments of the test strips andchemistries described;

FIG. 3 shows testing results for an embodiment of an electrochemicaltest strip for use in determining hemoglobin A1C, total hemoglobin, and% HbA1C; and

FIG. 4 shows testing results for an embodiment of an electrochemicaltest strip for use in determining hemoglobin A1C, total hemoglobin, and% HbA1C.

DESCRIPTION

Certain terminology is used herein for convenience only and is not to betaken as a limitation on the embodiments of the methods and systems forelectrochemical detection and quantification of hemoglobin A1C, totalhemoglobin, and % HbA1C. The preparation, detection and quantificationtechniques described herein enable quick and accurate electrochemicaldetection of % HbA1c.

Of particular note is the fact that the disclosed methods and systemsfor detecting blood hemoglobin may be used in a portable, low cost,point-of-care (POC) device. The testing requires only a fingerstick ofblood, rather than a venous draw, and the testing may therefore beperformed by self-testing at home.

Pre-Analytical Solution Preparation

The methods and systems are based on the preparation of anelectrochemical test solution suitable prepared from a whole bloodsample and suitable for electrochemical determination of both A1C andtotal hemoglobin. This electrochemical test solution comprises oxidizedfree hemoglobin from which FVH has been cleaved. In one aspect, theinitial preparation includes the following steps performed on a solutioncontaining free hemoglobin:

-   -   oxidation of free hemoglobin in a blood sample, and    -   cleavage of FVH from the free hemoglobin.

This yields an electrochemical test solution comprising hemoglobin, FVH,and hemoglobin degradation products. The oxidation and cleavage stepsmay be preceded by steps including obtaining a whole blood sample andlysing the red blood cells to provide the free hemoglobin solution.

Preparation of the electrochemical test solution may be accomplished bymixing the whole blood sample with a pre-analytical solution whichincludes components for one or more of the lysing, oxidizing andcleaving steps. The pre-analytical solution may also function to dilutethe test sample to a concentration appropriate for use in the analysis.In one aspect, the blood sample is mixed with the pre-analyticalsolution in a suitable ratio, such as a 1:5 ratio. Additional componentsalso may be included in the pre-analytical solution to provide otherfunctions such as buffering, preservation and stabilization.

It has been found that hemoglobin A1C and total hemoglobin may bedetermined from as little as a single drop of blood. However, inalternative embodiments the determination of hemoglobin utilizes eithercapillary or venous blood samples in volumes such as 10 μL to 100 μL,which may be drawn into Li-heparin or EDTA tubes.

There is a difference between capillary and venous blood. Capillaryblood typically reports higher levels of hemoglobin than venous blood.However, this difference is readily addressed by the use of differentcalibration curves based on the type of sample.

Lysing Agents

In most embodiments, including in the use of a POC system, the firststep in performing the assay is to lyse the red blood cells to releasethe hemoglobin. Lysing agents are well known in the art and include, forexample, Triton X-100 and other suitable surfactants. Many suchsurfactants are available, with some surfactants being more efficient atlysing red blood cells. The surfactant may, for example, be non-ionic,anionic, cationic, or zwitterionic. In one embodiment, a zwitterionicsurfactant is used as it keeps the slightly denatured hemoglobin insolution. Zwittergent 3-14 appears to keep the hemoglobin from fallingout of solution, making it unable to react with the protease. This is animportant characteristic of the surfactant.

Oxidation of the Free Hemoglobin

The pre-analytical solution further includes one or more components tooxidize the hemoglobin. Oxidation of the hemoglobin is an importantaspect of the assay. This allows cleavage of Fructosyl-Valine-Histidine(FVH) from the hemoglobin by the protease. Oxidation also removesinterference which would other result from the presence of reducedhemoglobin. That is, if the hemoglobin is not oxidized prior to cominginto contact with the mediator, it will be oxidized by the mediator,creating an electrochemical response and unwanted background.Unfortunately, many of the common substances that form methemoglobin arealso electrochemically active. Thus, an oxidizing agent is used thatoxidizes a high percentage of the heme iron of the hemoglobin to Fe⁺³,does not react electrochemically in the test system, and does notinterfere with the protease or the fructosyl peptide oxidase.

Various oxidizing agents are known and may be evaluated for use herein.These agents may oxidize the hemoglobin or may facilitate oxidation incombination with one or more other oxidizing agents. However, not alloxidizing agents are useful in the disclosed electrochemical hemoglobinmethod.

In one embodiment, TTAB and an isothiazoline derivative are used incombination, providing surprisingly superior results as compared to theuse of either agent alone. In an embodiment, 1-Dodecyl pyridiniumchloride is used as the cationic surfactant, and 1,2Benzisothiazol-3(2H)-one is used as the isothiazoline derivative.

Cleavage of FVH

The pre-analytical solution further includes a protease, such as NeutralEnzyme Proteinase (NEP) to cleave the FVH. The protease degrades theglycated hemoglobin selectively to a glycated hemoglobin degradationproduct. The resulting solution containing the FVH is testedelectrochemically for determining glycated hemoglobin.

In order to optimize the digestion of the protease, the hemoglobin isplaced in a relaxed state and is therefore able to unfold and spreadout. Commercial A1C assays for hospital analyzers have large dilutionfactors (e.g. 1 part blood to 100 parts reagent). However, in anelectrochemical POC assay, the sample cannot be diluted so much as tonot have enough signal to read. It is therefore important for a POCsystem that the protease work efficiently. In some embodiments,imidazole may be used as a hemoglobin ligand. Imidazole (C₃H₄N₂) bindsto the hemoglobin and thereby causes it to be in a relaxed state,allowing the protease to react more efficiently.

In various alternatives, other analogs of imidazole may be used. Analogsmay include Benzimidazole, Dihydroimidazole, Pyrrole, Oxazole, Thiazole,Pyrazole, Triazoles, Tetrazole, Pentazole, Furazan, Isothiazole,Thiazole, Thiadiazole, and various other Azoles. Additionally, histidineor other molecules having imidazole or an imidazole analog as a sidechain may enhance the protease. Other hemoglobin binding ligands such assodium azide and pyridine have been found to not have the same effect asimidazole.

Pre-Analytical Solution

By way of example, a suitable pre-analytical solution, adjusted to a pHof 7.5, can be made with the following components:

-   -   1.5% Triton X-100;    -   880 mM Imidazole;    -   10 mM NaCl;    -   3 mM CaCl2;    -   47.6 mM Tetradecyltrimethylammonium bromide (TTAB);    -   8.1 mM 1,2-benzoisothiazol-3-one sodium salt (Isothiazoline);        and    -   35 kU/mL NEP-801.

Glycated Hemoglobin

Determination of glycated hemoglobin A1C from the oxidized and cleaved,electrochemical test solution is accomplished by an electrochemicalmethod. The method involves the following steps:

-   -   reacting a first portion of the mixture with FPOX and a reduced        ruthenium mediator to form a first reaction product;    -   measuring an electrical property of the first reaction product        which is proportional to the amount of glycated A1C hemoglobin        in the sample; and    -   determining the amount of A1C in the blood sample from the        electrical measurement.

In one aspect, the electrochemical test solution containing FVH is dosedonto a test strip containing the FPOX and ruthenium hexamine trichloride(RuIII(NH₃)₆Cl₃) mediator. By way of example, the test strip is coatedwith a 100 mM solution of electrochemical test reagent including FPOX,the ruthenium mediator, and the following additional components:

-   -   Polymer—Polyethylene Oxide or Polyvinylacetate;    -   Surfactant—Triton-X-100; and    -   Buffer—N-tris(Hydroxymethyl)methyl-4-aminobutanesulfonic acid        (TABS) 100 mM.

The resulting reaction generates electrons which produce a current thatis proportional to the FVH in the sample.

Total Hemoglobin

In another aspect, the methods and systems include the determination oftotal hemoglobin from a second portion of the oxidized electrochemicaltest solution. With the heme iron as Fe⁺³, it has been determined that areaction with ferrocyanide allows for measurement of the reduction ofthe hemoglobin as an accurate indicator of total hemoglobin.

In a particular aspect, the second portion of the electrochemical testsolution is reacted with a test reagent comprising ferrocyanide(potassium hexacyanoferrate Fe⁺²) to form a second reaction product.FPOX is not needed for the total hemoglobin reaction. A secondelectrical property of the second reaction product is measured which isproportional to the amount of total hemoglobin in the blood sample.Further, the electrochemical determinations of both A1C and totalhemoglobin are used to derive the % HbA1C for the blood sample.

The electrochemical test solution is dosed onto a test strip containingthe FPOX and ferrocyanide mediator. By way of example, the test strip iscoated with a 100 mM solution of electrochemical test reagent includingFPOX, the ferrocyanide mediator, and the following components:

-   -   Polymer—Polyethylene Oxide or Polyvinylacetate;    -   Surfactant—Triton-X-100; and    -   Buffer—N-tris(Hydroxymethyl)methyl-4-aminobutanesulfonic acid        (TABS) 100 mM.

The electrochemical test solution is dosed onto the test strip.Following a 10 second rest time, a negative current of −525 mV isapplied for a suitable period of time, e.g., twenty seconds. Thisreaction generates electrons which produce a current that isproportional to the total hemoglobin in the sample. The steady statecurrent is proportional to the amount of hemoglobin in the sample.

Reacting FPOX/ferrocyanide with the oxidized electrochemical testsolution resulted in the cyclic voltammetry curve of current versuspotential, showing a peak around −450 mV shown in FIG. 2 .

Test Strip Design

The foregoing reactions suitably, but not necessarily, take place ontest strips. The test strips may have a variety of designs, and may beselected, for example, from a number of test strips known in the art tobe useful for electrochemical tests of this general type.

In a basic design, the test strips include a non-conductive base layerwith a conductive layer deposited on top which is ablated to make anelectrode pattern. The electrode pattern may include, for example, aworking electrode, a counter electrode, and one or more fill detectelectrodes. The electrode material can be platinum, palladium, carbon,gold, or other suitable materials, with gold being preferred. A spaceris laid over the electrode pattern and a roof is placed on top of thespacer, thereby defining a capillary passageway from a dose port to areaction chamber. The roof contains a hole to vent air as the testsolution flows into the reaction space by capillary action.

Referring to FIG. 1 , the test strip is shown as having a workingelectrode, counter electrode, and a fill detect electrode. The strip ismade with gold coated on a polyethylene surface. The size, shape andspacing of the working and counter electrodes is not critical and may bedetermined by those skilled in the art without undue experimentation.The electrodes may be interdigitated to increase signal response. In oneembodiment, the electrode elements have a spacing of 38 μm to 100 μm.Smaller spacings may further increase the signal observed. In FIG. 1 ,electrode lead 3A includes a loop portion 3B, that allows the insertionof the test strip to be detected by the meter using a u-shaped circuit.The upper portion, interconnector 3C, interconnects to one half of theelectrodes of electrodes 6. The upper portion, interconnector 5B,interconnects to the other half of the electrodes of electrodes 6, sothat one half of the electrodes may function as an electrode and theother half a counter electrode. Additionally, a reference electrodeinterconnector 4B may be included as is typical. Dielectrics 7, asshown, surround the test area and serve to prevent current or voltageleakage during testing. Typically, dielectrics 7 comprise, glass,sitall, or other insulting ceramic.

The test strip is prepared to include the electrochemical test reagentcontaining the FPOX and mediator in the reaction chamber. Theelectrochemical test reagent has a suitable pH as known in the art, suchas 10.5, and may further include other components, such as thefollowing:

-   -   DI Water    -   Polyethylene Oxide (1%)    -   Triton-X 100 (0.1%)    -   TABS Buffer (20 mM)        The test strip reagent is formulated and then applied to the        test strip and allowed to dry.

Calibration Curves

The electrochemical reaction schemes disclosed herein are suitable foruse in conventional fashion with calibration curves. A calibration curvemay be developed which correlates the response signal to a concentrationof A1C or total hemoglobin. As known in the art, a series of tests areconducted at varying concentrations of A1C and total hemoglobin in orderto establish a correlation to signal response for the desired range ofconcentrations. The results provide calibration curves for theelectrochemical tests correlating, for example, the electrochemicalsignal in nanoamps (nA) with the concentration of hemoglobin inmillimolar (mM) units. In the alternative, an algorithm, look-up table,or the like may instead or in addition be derived which similarlycorrelates the response signal to concentration.

EXAMPLES

Experiments have been performed showing the excellent determination ofA1C and total hemoglobin using the disclosed electrochemical methods andsystems.

Example 1—Pre-Analytical Solution

In an exemplary embodiment, the pre-analytical solution, adjusted to apH of 7.5, was made with the following components:

-   -   1.5% Triton X-100;    -   880 mM Imidazole;    -   10 mM NaCl;    -   3 mM CaCl2;    -   47.6 mM Tetradecyltrimethylammonium bromide (TTAB);    -   8.1 mM 1,2-benzoisothiazol-3-one sodium salt (Isothiazoline) and    -   35 kU/mL NEP-801.

Example 2—Test Strip

A test strip was prepared having interdigitated working and counterelectrodes. A third electrode was provided for fill detection. Theelectrode material was gold and was coated on a polyethylene base film.The electrodes were produced by laser ablation. A spacer defined thereagent chamber and a roof with vent hole functioned as a lid.

Each strip was coated with a 100 mM solution of the electrochemical testreagent. For total hemoglobin, for example, ferrocyanide buffered to 6.5to 11 pH was used. Polyvinylacetate was used to help reagent setup.Triton-X 100 was added to help spread the reagent over the electrodearea. In one embodiment, the reactants were combined with the followingcomponents and had a pH of 9.5:

-   -   Polymer—Polyethylene Oxide or Polyvinylacetate;    -   Surfactant—Triton-X-100; and    -   Buffer—N-tris(Hydroxymethyl)methyl-4-aminobutanesulfonic acid        (TABS) 100 mM.        The total mixture was applied to at least the working electrode        and allowed to dry.

Example 3—Total Hemoglobin

Blood was taken from 1 or more donors and hematocrit was adjusted,usually within a range of 20-60%. Blood was mixed with thepre-analytical solution at a 1:5 ratio, usually using 25 uL of blood to125 uL of pre-analytical solution. This mixture was then heated at 37°C. for 5 minutes. As described herein, the combining of the blood samplewith the pre-analytical solution resulted in lysing of the red bloodcells, oxidation of reduced hemoglobin iron to Fe⁺³, and cleaving of theFVH.

A test strip prepared in accordance with Example 2 and containingferrocyanide as the mediator was dosed with the heated electrochemicaltest solution. Detection of a dose at the dose detect electrode wasfollowed by a hold time of 10 seconds. A negative potential of −525 mVwas then applied for twenty seconds. The measured current at 10 secondsof measurement (20 seconds after dose detection) was proportionate tothe amount of total hemoglobin in the sample as shown in FIG. 3 .

Plotting the current measured against time gave a decay that reached asteady state, usually 5-10 seconds after the start of the reaction. Thecurrent at 10 seconds was indicative of the amount of hemoglobin in thesample. Smoothing techniques such as rolling averages may be used toincrease precision of the measurement. Total hemoglobin was determinedusing a Hemocue Hb 201+ as a reference method.

Example 5

The reaction of ferrocyanide with the oxidized hemoglobin solutionyielded a cyclic voltammogram of ferrocyanide in solution with andwithout blood/pre-analytical solution sample mixture shown in FIG. 4 .

CONCLUSION

While specific embodiments have been described in the foregoing detaileddescription, it will be appreciated by those skilled in the art thatvarious modifications and alternatives to those details could bedeveloped in light of the overall teachings of the disclosure and thebroad inventive concepts thereof. It is understood, therefore, that thescope of this disclosure is not limited to the particular examples andimplementations disclosed herein but is intended to cover modificationswithin the spirit and scope thereof as defined by the appended claimsand any and all equivalents thereof.

What is claimed as new and desired to be protected by Letters Patent ofthe United States is:
 1. A system for the determination of A1C and totalhemoglobin comprising: a sampler including a pre-analytical solutioncomprising components for lysing red blood cells, oxidizing freehemoglobin to Fe⁺³, and cleaving FVH from free hemoglobin to form anelectrochemical test solution; a first test strip including a reactionchemistry comprising fructosyl peptide oxidase and a reduced rutheniummediator for the electrochemical determination of A1C; and a second teststrip including a reaction chemistry comprising fructosyl peptideoxidase and ferrocyanide for the electrochemical determination of totalhemoglobin.
 2. The system of claim 1, wherein the pre-analyticalsolution includes a Neutral Enzyme Proteinase.
 3. The system of claim 1,wherein the pre-analytical solution includes Zwittergent 3-14.
 4. Thesystem of claim 1, wherein the pre-analytical solution includes: 1.5%Triton X-100; 880 mM Imidazole; 10 mM NaCl; 3 mM CaCl2; 47.6 mMTetradecyltrimethylammonium bromide (TTAB); 8.1 mM1,2-benzoisothiazol-3-one sodium salt (Isothiazoline); and 35 kU/mLNEP-801.
 5. The system of claim 1, wherein the pre-analytical solutionis configured to be combined with a sample and applied to both the firstand second test strip to achieve an analytical result.